RESUMEN

In the last decade, a number of new device technologies were developed for benign prostatic hyperplasia (BPH) therapy. These technologies were introduced in an effort to reduce the morbidity of BPH therapy associated with conventional electrocautery transurethral resection of the prostate (TURP). While morbidity is reduced, the aim of new therapy is to achieve near equivalence in efficacy of outcome measures, namely, improved voided flow rate and reduced symptom score. To gain acceptance by urologists, these technologies should be easy to apply and should reduce the economic cost of BPH treatment. The Indigo 830e diode laser system offers simplified laser therapy from a miniaturized solid-state system. This pilot study demonstrates outcome equivalence to TURP in preliminary evaluation and shows an acceptable side effect profile.

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We concluded a prospective randomised study comparing conventional electrocautery transurethral resection of the prostate (TURP) to laser prostatectomy using a right-angled Nd:YAG beam reflector. Seventy-one patients were evaluable, 34 laser and 37 TURP. Fifty patients have completed 6 months of follow-up. Using standard post prostatectomy outcome parameters of maximum flow rate and post void residual urine, laser prostatectomy shows equivalence at 6 months, with mean maximum flow rates of 8.76 ml/sec preoperatively improving to 15.47 ml/sec at 6 months, whilst for TURP patients, flow rates improved from a mean of 9.48 ml/sec preoperatively to 19.1 ml/sec at 6 months. Symptom scores remain higher for the laser patients at this time with a mean score of 9.27 compared to 4.43 for TURP patients. However, morbidity in the laser group is less, particularly given the absence of postoperative bleeding and the necessity for blood transfusion.

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Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.

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Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.

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OBJECTIVE: To assess the effectiveness of a second-generation laser delivery system (Side-Fire) in the treatment of benign prostatic hyperplasia (BPH). METHODS: Thirty-three patients with documented BPH were treated and evaluated pre- and post-operatively with a follow-up period of twelve to thirty-six weeks. RESULTS: There was marked improvement demonstrated at three months post lasing in all patient outcome parameters (symptom score, flow rate, and post-void residual volume) using the new Side-Fire right-angled delivery system. CONCLUSION: Side-Fire catheter laser ablation therapy produces an excellent transition zone ablation in established BPH.

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Total bladder replacement with an ileal neobladder was performed in five male patients undergoing cystoprostatectomy. The surgical technique and short-term results are reported. Four of these patients exhibited total urinary continence day and night. One patient was totally continent during the day but had difficulty with continence at night due to mucus leakage. All patients demonstrated satisfactory bladder emptying (average post-micturition residual < 40 mL) with a flow rate of 4-15 mL/s. Until 1989 the ileal conduit, first described by Bricker in 1950, was used as the preferred method of urinary diversion. We believe that the ileal neobladder in male patients is an excellent bladder substitute with an associated low operative and peri-operative morbidity and a high long-term continence rate, allowing the patient to be free from urostomy.

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A simple circuit is described which is used to maintain continuity of a radio-frequency or microwave induced plasma. The microwave power reflected from the discharge is monitored. Upon an increase of the reflected power which indicates that the plasma has become extinguished, a high-voltage pulse is applied to a coil wrapped around the discharge region. The repetition rate, voltage of the pulse, and threshold of reflected power are adjustible. This circuit is applicable to resonance fluorescence, atomic absorption and emission, and kinetic determinations.